| NPI | 1518976661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY L CANTWELL President 386-239-0021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL 1020) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2017-05-11 |